Ovulation Induction

A 31-year-old woman with PCOS and anovulation has undergone 3 cycles of clomiphene citrate (CC) 100 mg daily for 5 days without achieving ovulation. Baseline FSH is 4.2 mIU/mL, LH is 18 mIU/mL, and testosterone is 0.8 ng/mL. She has no contraindications to gonadotropins. What is the most appropriate next step in management?

A 32-year-old woman with PCOS and secondary infertility for 18 months presents with irregular cycles (45–60 days). BMI is 28 kg/m². Basal FSH is 6 IU/L, LH is 18 IU/L (LH:FSH ratio 3:1), and free testosterone is elevated. She has not conceived after 6 months of clomiphene citrate 100 mg daily (days 3–7) with documented ovulation on ultrasound. What is the most appropriate next step in management?

A 32-year-old woman with hypothalamic amenorrhea (BMI 18.5 kg/m², normal prolactin and TSH) has failed to conceive despite 18 months of unprotected intercourse and weight restoration. What is the drug of choice for ovulation induction in this patient?

A 28-year-old woman with PCOS-related anovulation is counselled about ovulation induction agents. Which feature best distinguishes clomiphene citrate from letrozole in terms of mechanism and clinical effect?

A 32-year-old woman with unexplained infertility is being considered for gonadotropin therapy vs. GnRH agonist co-treatment. Which clinical feature best distinguishes the risk profile and outcome of gonadotropin monotherapy from GnRH agonist + gonadotropin combination in terms of ovarian hyperstimulation and follicle development?